This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Wednesday, October 07, 2015

A Simple Text Message Or Two Can Make A Difference It Seems! Good Inexpensive Stuff.

NEW Australian research showing text messaging can be an effective health promotion tool for patients with coronary heart disease has been welcomed by experts, but they say more sophisticated, individualised approaches could yield even greater health benefits. (1)

Professor Sven-Erik Bursell, professor of telehealth at the NHMRC Clinical Trials Centre, Sydney Medical School, said existing mobile technology could be used to personalise health education for patients, to help them sustain lifestyle modification over longer periods and improve clinical outcomes.

“We can go a long way beyond your generic SMS [short message service] and, if we can do this in a meaningful way, then the clinical outcomes improvement and health impacts can increase significantly”, Professor Bursell told MJA InSight.

Professor Bursell was commenting on the Australian research published in JAMA that found providing lifestyle advice and motivational messages to patients with coronary heart disease (CHD) over a 6-month period improved risk factors compared with usual care.

The single-blind, randomised clinical trial included 710 patients with proven CHD. In addition to usual care, the 352 patients in the intervention group received four text messages each week via an automated messaging service. The messages were sourced from a bank of standard messages, but were targeted according to patients’ baseline characteristics, and were sometimes personally addressed.

The low-cost program led to significant reductions in low-density lipoprotein cholesterol levels, systolic blood pressure and body mass index. Participants receiving the text messages were also more likely to report engaging in regular exercise and being non-smokers.

Professor Bursell said the study added to the evidence gathered over the past decade that text messaging could play a positive role in health promotion. However, he said that to sustain the health benefits in the long term, a more individualised approach was necessary.

“You really have to evolve your text messaging paradigm so it becomes both contextually and temporally relevant to the patient, so you’re providing the right tip at the right time for that patient”, he said. “If you don’t evolve with the patient, then the text messaging to the patient just becomes clutter.”

Professor Bursell said an example was a patient being reminded to make a healthy choice just as they were about to enter a restaurant. Incentives could also be incorporated into programs, delivering small rewards to patients when health goals were attained.

Researchers in Australia randomized some 700 adults with CHD to usual care (e.g., cardiac rehab) with or without a text messaging intervention. Patients in the intervention group received four automated, albeit semipersonalized, text messages each week aimed at improving diet, physical activity, and general cardiovascular health; smokers also received texts that promoted smoking cessation.

At 6 months, mean LDL cholesterol was significantly lower in the intervention group than in the control group (79 vs. 84 mg/dL), as was systolic blood pressure (128 vs. 136 mm Hg) and BMI (29.0 vs. 30.3). Intervention participants were also significantly more likely to exercise regularly and abstain from smoking.

The intervention cost less than $10 per participant, the authors note.

Dr. Thomas Schwenk of NEJM Journal Watch General Medicine said the findings "should be replicated in broader populations that are followed for a longer time, with actual clinical outcomes assessed." Nonetheless, he adds, the observed effect of such a low-cost intervention "is impressive."